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Laberge M, Brundisini FK, Zomahoun HTV, Sawadogo J, Massougbodji J, Gogovor A, David G, Légaré F. Knowledge exchange sessions on primary health care research findings in public libraries: A qualitative study with citizens in Quebec. PLoS One 2023; 18:e0289153. [PMID: 37490456 PMCID: PMC10368291 DOI: 10.1371/journal.pone.0289153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
Little is known about knowledge transfer with the public. We explored how citizens, physicians, and communication specialists understand knowledge transfer in public spaces such as libraries. The initial study aimed at evaluating the scaling up of a program on disseminating research findings on potentially inappropriate medication. Twenty-two citizen workshops were offered by 16 physicians and facilitated by 6 communication specialists to 322 citizens in libraries during spring 2019. We did secondary analysis using the recorded workshop discussions to explore the type of knowledge participants used. Participants described four kinds of knowledge: biomedical, sociocultural beliefs, value-based reasoning, and institutional knowledge. Biomedical knowledge included scientific evidence, research methods, clinical guidelines, and access to research outcomes. Participants discussed beliefs in scientific progress, innovative clinical practices, and doctors' behaviours. Participants discussed values related to reliability, transparency, respect for patient autonomy and participation in decision-making. All categories of participants used these four kinds of knowledge. However, their descriptions varied particularly for biomedical knowledge which was described by physician-speakers and communication specialists-facilitators as scientific evidence, epidemiological and clinical practice guidelines, and pathophysiological theories. Communication specialists-facilitators also described scientific journalistic sources and scientific journalistic reports as proxies of scientific evidence. Citizens described biomedical knowledge in terms of knowledge to make informed decisions. These findings offer insights for future scientific knowledge exchange interventions with the public.
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Affiliation(s)
- Maude Laberge
- Faculty of Medicine, Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Université Laval, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
| | - Francesca Katherine Brundisini
- Faculty of Medicine, Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
| | - Hervé Tchala Vignon Zomahoun
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Jasmine Sawadogo
- First Nations of Quebec and Labrador Health and Social Services Commission, Quebec, Canada
| | - José Massougbodji
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Amédé Gogovor
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
| | - Geneviève David
- Centre d'excellence sur le Partenariat avec les Patients et le Public, Centre de Recherche du CHUM, Québec, Canada
- École Nationale d'administration Publique, Québec, Canada
| | - France Légaré
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Université Laval, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
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Friesen I. Humanitarians' ethics: the role of face-to-face experiences in humanitarian aid workers' motivation. DISASTERS 2023; 47:23-41. [PMID: 34939693 DOI: 10.1111/disa.12531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This paper analyses the significance of specific ethical experiences for humanitarian aid workers' motivation. Following Emmanuel Levinas's understanding of ethics as arising from intersubjective face-to-face encounters, the study illuminates the experiential origins of the humanitarian commitment by analysing James Orbinski's memoir entitled An Imperfect Offering: Dispatches from the Medical Frontline. Orbinski, a former International Council President at Médecins Sans Frontières, was directly involved in humanitarian responses to several major crises during the 1990s, including those in Somalia, Afghanistan, Rwanda, and what was then Zaire. This paper explores three formative experiences from Orbinski's childhood and teenage years to analyse the personal ethics of humanitarian aid workers and to illuminate the intersection of the personal and professional level of humanitarian aid work. Illustrating that Orbinski's humanitarian commitment is a surrendering to the other's call, the paper argues for stronger inclusion of aid workers' lives and experiences to achieve a comprehensive understanding of humanitarian work.
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Affiliation(s)
- Ina Friesen
- Senior Researcher, International and Transnational Cooperation, German Institute of Development and Sustainability (IDOS), Germany
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Parry AE, Kirk MD, Colquhoun S, Durrheim DN, Housen T. Leadership, politics, and communication: challenges of the epidemiology workforce during emergency response. HUMAN RESOURCES FOR HEALTH 2022; 20:33. [PMID: 35410336 PMCID: PMC8995686 DOI: 10.1186/s12960-022-00727-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/25/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND Improving the epidemiological response to emergencies requires an understanding of who the responders are, their role and skills, and the challenges they face during responses. In this paper, we explore the role of the epidemiologist and identify challenges they face during emergency response. METHODS We conducted a cross-sectional survey to learn more about epidemiologists who respond to public health emergencies. The online survey included open and closed-ended questions on challenges faced while responding, the roles of epidemiology responders, self-rating of skills, and support needed and received. We used purposive sampling to identify participants and a snowballing approach thereafter. We compared data by a number of characteristics, including national or international responder on their last response prior to the survey. We analysed the data using descriptive, content, and exploratory factor analysis. RESULTS We received 166 responses from individuals with experience in emergency response. The most frequently reported challenge was navigating the political dynamics of a response, which was more common for international responders than national. National responders experienced fewer challenges related to culture, language, and communication. Epidemiology responders reported a lack of response role clarity, limited knowledge sharing, and communication issues during emergency response. Sixty-seven percent of participants reported they needed support to do their job well; males who requested support were statistically more likely to receive it than females who asked. CONCLUSIONS Our study identified that national responders have additional strengths, such as better understanding of the local political environment, language, and culture, which may in turn support identification of local needs and priorities. Although this research was conducted prior to the COVID-19 pandemic, the results are even more relevant now. This research builds on emerging evidence on how to strengthen public health emergency response and provides a platform to begin a global conversation to address operational issues and the role of the international epidemiology responder.
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Affiliation(s)
- Amy Elizabeth Parry
- National Centre for Epidemiology & Population Health (NCEPH), Acton, ACT, The Australian National University (ANU), Building 62 Mills Road, Canberra, Australia
| | - Martyn D. Kirk
- National Centre for Epidemiology & Population Health (NCEPH), Acton, ACT, The Australian National University (ANU), Building 62 Mills Road, Canberra, Australia
| | - Samantha Colquhoun
- National Centre for Epidemiology & Population Health (NCEPH), Acton, ACT, The Australian National University (ANU), Building 62 Mills Road, Canberra, Australia
| | | | - Tambri Housen
- National Centre for Epidemiology & Population Health (NCEPH), Acton, ACT, The Australian National University (ANU), Building 62 Mills Road, Canberra, Australia
- University of Newcastle, Newcastle, NSW Australia
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Côté LP, Drolet MJ. Conceptualizing Ethical Issues of Humanitarian Work: Results From a Critical Literature Review. CANADIAN JOURNAL OF BIOETHICS 2021. [DOI: 10.7202/1077631ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article presents results of a critical review of the literature discussing the ethical issues arising in humanitarian work, following the method proposed by McCullough, Coverdale and Chervenak. Our aim was primarily to focus on how the ethical issues arising in humanitarian work are conceptualized within the literature we reviewed. We think that properly conceptualizing the ethical issues which humanitarian workers may face can provide avenues to better respond to them. We analysed 61 documents, as part of a literature review, which revealed that there truly is a need, amongst the authors and in humanitarian work, to discuss ethics. Indeed, even if only a small number of authors define explicitly the words they use to discuss ethics, the great quantity that we have uncovered in the documents seem to suggest vast and rich grounds upon which to address ethical issues. We believe it to be important that the ethical issues of humanitarian work are increasingly addressed in the literature and argue that it would be helpful for the vocabulary used by authors to be employed and developed even more rigorously, so that their discussions show more precision, coherence, relevance, exhaustiveness, and sufficiency. The review of the literature, as well as the resulting analysis in this article, is part of a broader project to suggest a way to conceptualize the ethical issues of humanitarian work based on the strengths and innovations of this and other studies.
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Affiliation(s)
- Louis Pierre Côté
- Department of Philosophie and the Arts, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Marie-Josée Drolet
- Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Parry AE, Kirk MD, Durrheim DN, Olowokure B, Colquhoun S, Housen T. Emergency response and the need for collective competence in epidemiological teams. Bull World Health Organ 2021; 99:351-358. [PMID: 33958823 PMCID: PMC8061673 DOI: 10.2471/blt.20.276998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To determine the challenges met by, and needs of, the epidemiology emergency response workforce, with the aim of informing the development of a larger survey, by conducting key informant interviews of public health experts. Methods We defined our study population as public health experts with experience of epidemiology deployment. Using purposive sampling techniques, we applied random number sampling to shortlists of potential interviewees provided by key organizations to obtain 10 study participants; we identified three additional interviewees through snowballing. The same interviewer conducted all key informant interviews during May-August 2019. We thematically analysed de-identified transcripts using a qualitative data analysis computer software package. Findings Despite our interviewees having a wide range of organizational and field experience, common themes emerged. Interviewees reported a lack of clarity in the definition of an emergency response epidemiologist; the need for a broader range of skills; and inadequate leadership and mentoring in the field. Interviewees identified the lack of interpersonal skills (e.g. communication) and a lack of career progression options as limitations to the effectiveness of emergency response. Conclusion The epidemiology emergency response workforce is currently not achieving collective competence. The lack of a clear definition of the role must be addressed, and leadership is required to develop teams in which complementary skills are harmonized and those less experienced can be mentored. Epidemiology bodies must consider individual professional accreditation to ensure that the required skills are being achieved, as well as enabling continual professional development.
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Affiliation(s)
- Amy Elizabeth Parry
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Building 62, Mills Road, Acton, Canberra, Australian National Territory, 2601 Australia
| | - Martyn D Kirk
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Building 62, Mills Road, Acton, Canberra, Australian National Territory, 2601 Australia
| | - David N Durrheim
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Babatunde Olowokure
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Samantha Colquhoun
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Building 62, Mills Road, Acton, Canberra, Australian National Territory, 2601 Australia
| | - Tambri Housen
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Building 62, Mills Road, Acton, Canberra, Australian National Territory, 2601 Australia
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McGowan CR, Baxter L, DuBois M, Sheather J, Khondaker R, Cummings R, Watkins K. Preparing humanitarians to address ethical problems. Confl Health 2020; 14:72. [PMID: 33292441 PMCID: PMC7610160 DOI: 10.1186/s13031-020-00319-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 10/22/2020] [Indexed: 11/10/2022] Open
Abstract
Infectious disease outbreaks represent potentially catastrophic threats to those affected by humanitarian crises. High transmissibility, crowded living conditions, widespread co-morbidities, and a lack of intensive care capacity may amplify the effects of the outbreak on already vulnerable populations and present humanitarian actors with intense ethical problems. We argue that there are significant and troubling gaps in ethical awareness at the level of humanitarian praxis. Though some ethical guidance does exist most of it is directed at public health experts and fails to speak to the day-to-day ethical challenges confronted by frontline humanitarians. In responding to infectious disease outbreaks humanitarian workers are likely to grapple with complex dilemmas opening the door to moral distress and burnout.
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Affiliation(s)
- Catherine R McGowan
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK.
- Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Louisa Baxter
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
| | - Marc DuBois
- Department of Development Studies, SOAS University of London, 10 Thornhaugh Street, Russell Square, London, WC1H 0XG, UK
| | - Julian Sheather
- Médecins Sans Frontières/Doctors Without Borders (MSF), Lower Ground Floor, Chancery Exchange, 10 Furnival Street, London, EC4A 1AB, UK
| | - Ruma Khondaker
- Mental Health and Psychosocial Support, Save the Children Bangladesh, Rohingya Response, Cox's Bazaar, Bangladesh
| | - Rachael Cummings
- Humanitarian Public Health Technical Unit, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
| | - Kevin Watkins
- Chief Executive Officer, Save the Children UK, 1 St John's Lane, London, EC1M 4AR, UK
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Parry AE, Kirk MD, Durrheim DN, Olowokure B, Housen T. Study protocol: building an evidence base for epidemiology emergency response, a mixed-methods study. BMJ Open 2020; 10:e037326. [PMID: 32601115 PMCID: PMC7328751 DOI: 10.1136/bmjopen-2020-037326] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Determinants and drivers for emergencies, such as political instability, weak health systems, climate change and forcibly displaced populations, are increasing the severity, complexity and frequency of public health emergencies. As emergencies become more complex, it is increasingly important that the required skillset of the emergency response workforce is clearly defined. To enable essential epidemiological activities to be implemented and managed during an emergency, a workforce is required with the right mix of skills, knowledge, experience and local context awareness. This study aims to provide local and international responders with an opportunity to actively contribute to the development of new thinking around emergency response roles and required competencies. In this study, we will develop recommendations using a broad range of evidence to address identified lessons and challenges so that future major emergency responses are culturally and contextually appropriate, and less reliant on long-term international deployments. METHOD AND ANALYSIS We will conduct a mixed-methods study using an exploratory sequential study design. The integration of four data sources, including key informant interviews, a scoping literature review, survey and semistructured interviews will allow the research questions to be examined in a flexible, semistructured way, from a range of perspectives. The study is unequally weighted, with a qualitative emphasis. We will analyse all activities as individual components, and then together in an integrated analysis. Thematic analysis will be conducted in NVivo V.11 and quantitative analysis will be conducted in Stata V.15. ETHICS AND DISSEMINATION All activities have been approved by the Science and Medical Delegated Ethics Review Committee at the Australian National University (protocol numbers 2018-521, 2018-641, 2019-068). Findings will be disseminated through international and local deployment partners, peer-reviewed publication, presentation at international conferences and through social media such as Twitter and Facebook.
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Affiliation(s)
- Amy Elizabeth Parry
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Martyn D Kirk
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - David N Durrheim
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Babatunde Olowokure
- Health Emergencies Programme, World Health Organization, Geneve, Switzerland
| | - Tambri Housen
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Schneider M, Chappuis F, Pautex S. How do expatriate health workers cope with needs to provide palliative care in humanitarian emergency assistance? A qualitative study with in-depth interviews. Palliat Med 2018; 32:1567-1574. [PMID: 30113246 DOI: 10.1177/0269216318794091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Given the worldwide increase of chronic diseases, expatriate health workers on assignment with humanitarian emergency organisations can face more clinical situations that require advanced pain control or palliative care. Multiple reasons can prevent the provision of this care. AIM To better know how health workers react to and cope with this dilemma. DESIGN A qualitative interview study using inductive thematic analysis was performed. SETTING/PARTICIPANTS A total of 15 expatriate health workers took part in individual in-depth interviews after their assignment with the organisation 'Médecins sans Frontières'. RESULTS Clinical situations requiring advanced pain control or palliative care do occur during assignments. Expatriate health workers have different levels of knowledge of pain control and palliative care. Lacking opioids were a main reason for inadequate pain control. The expatriates felt helpless, distressed and frustrated in such situations. Peer support was sometimes helpful. Guidelines for palliative care in emergency settings would have been useful. CONCLUSION Pain control and palliative care needs occur during clinical practice in emergency humanitarian assistance. Training for expatriate health workers should be improved. Humanitarian organisations should strengthen their capacity to provide pain control and palliative care by developing and applying adapted guidelines.
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Affiliation(s)
- Martin Schneider
- 1 Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - François Chappuis
- 2 Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophie Pautex
- 3 Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
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Kwag M, Lee O. Difficulties faced by Korean disaster relief workers while providing humanitarian aid: A descriptive study. Nurs Health Sci 2018; 21:141-147. [PMID: 30328230 DOI: 10.1111/nhs.12577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/09/2018] [Accepted: 08/31/2018] [Indexed: 11/30/2022]
Abstract
The aim of the present study was to identify difficulties experienced by Korean disaster relief workers during humanitarian aid deployment. A convenience sample of disaster relief workers aged >18 years, who had been dispatched to an overseas disaster site, were recruited; 107 relief workers completed the Humanitarian Aid Difficulty Scale that consists of 23 items comprising five factors. The average difficulty rating was 2.64 on a five point scale. By item, participants gave the highest scores for bathroom use and the lowest scores for cooperation among team members. By factor, infrastructure was rated as the greatest difficulty, followed by health conditions, goods and equipment, culture and customs, and cooperation. Considering sociodemographic characteristics, there were significant age differences in the culture and customs factor, as well as significant occupation differences in the cooperation, culture and customs, and goods and equipment factors. These findings highlight the need to improve the welfare of workers. It is recommended that further research be conducted according to occupation and with repeated measurement prior to, in the middle of, and after deployment of relief workers.
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Affiliation(s)
- Myeongji Kwag
- VIP Ward, Sun Healthcare International, Daejeon, Korea
| | - Ogcheol Lee
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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Albuquerque S, Eriksson A, Alvesson HM. The rite of passage of becoming a humanitarian health worker: experiences of retention in Sweden. Glob Health Action 2018; 11:1417522. [PMID: 29334324 PMCID: PMC5769809 DOI: 10.1080/16549716.2017.1417522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Low retention of humanitarian workers poses constraints on humanitarian organisations’ capacity to respond effectively to disasters. Research has focused on reasons for humanitarian workers leaving the sector, but little is known about the factors that can elucidate long-term commitment. Objective: To understand what motivates and supports experienced humanitarian health workers to remain in the sector. Methods: Semi-structured interviews were conducted with 10 experienced nurses who had been on at least three field missions with Médecins Sans Frontières Sweden. Interviews explored factors influencing the decision to go on missions, how nurses were supported and how they looked back on those experiences. Transcripts were analysed through content analysis informed by van Gennep’s concept of ‘Rite of Passage’, combined with elements of the self-determination theory. Results: The findings indicate that their motivations and how nurses thought of themselves, as individuals and professionals, changed over time. For initiation and continued engagement in humanitarian work, participants were motivated by several personal and professional ambitions, as well as altruistic principles of helping others. When starting their first humanitarian missions, nurses felt vulnerable and had low self-esteem. However, through experiencing feelings of autonomy, competence and relatedness during missions, they underwent a process of change and gradually adjusted to new roles as humanitarian health workers. Reintegration in their home community, while maintaining the new roles and skills from the missions, proved very challenging. They individually found their own ways of overcoming the lack of social support they experienced after missions in order to sustain their continuation in the sector. Conclusions: The findings highlight the importance of social environments that facilitate and support the adjustment of individuals during and after field missions. Learning from positive examples, such as nurses with several years of experience, can strengthen strategies of retention, which can ultimately improve the delivery of humanitarian assistance.
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Affiliation(s)
- Sara Albuquerque
- a Department of Public Health Sciences, Global Health , Karolinska Institutet , Stockholm , Sweden
| | - Anneli Eriksson
- a Department of Public Health Sciences, Global Health , Karolinska Institutet , Stockholm , Sweden
| | - Helle M Alvesson
- a Department of Public Health Sciences, Global Health , Karolinska Institutet , Stockholm , Sweden
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Civaner MM, Vatansever K, Pala K. Ethical problems in an era where disasters have become a part of daily life: A qualitative study of healthcare workers in Turkey. PLoS One 2017; 12:e0174162. [PMID: 28319151 PMCID: PMC5358848 DOI: 10.1371/journal.pone.0174162] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 01/14/2017] [Indexed: 11/18/2022] Open
Abstract
Background Natural disasters, armed conflict, migration, and epidemics today occur more frequently, causing more death, displacement of people and economic loss. Their burden on health systems and healthcare workers (HCWs) is getting heavier accordingly. The ethical problems that arise in disaster settings may be different than the ones in daily practice, and can cause preventable harm or the violation of basic human rights. Understanding the types and the determinants of ethical challenges is crucial in order to find the most benevolent action while respecting the dignity of those affected people. Considering the limited scope of studies on ethical challenges within disaster settings, we set upon conducting a qualitative study among local HCWs. Methods Our study was conducted in six cities of Turkey, a country where disasters are frequent, including armed conflict, terrorist attacks and a massive influx of refugees. In-depth interviews were carried out with a total of 31 HCWs working with various backgrounds and experience. Data analysis was done concurrently with ongoing interviews. Results Several fundamental elements currently hinder ethics in relief work. Attitudes of public authorities, politicians and relief organizations, the mismanagement of impromptu humanitarian action and relief and the media's mindset create ethical problems on the macro-level such as discrimination, unjust resource allocation and violation of personal rights, and can also directly cause or facilitate the emergence of problems on the micro-level. An important component which prevents humanitarian action towards victims is insufficient competence. The duty to care during epidemics and armed conflicts becomes controversial. Many participants defend a paternalistic approach related to autonomy. Confidentiality and privacy are either neglected or cannot be secured. Conclusion Intervention in factors on the macro-level could have a significant effect in problem prevention. Improving guidelines and professional codes as well as educating HCWs are also areas for improvement. Also, ethical questions exposed within this study should be deliberated and actualized with universal consensus in order to guide HCWs and increase humane attitudes.
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Affiliation(s)
- M. Murat Civaner
- Department of Medical Ethics, Uludag University School of Medicine, Bursa, Turkey
- * E-mail:
| | - Kevser Vatansever
- Department of Medical Education, Ege University School of Medicine, Izmir, Turkey
| | - Kayihan Pala
- Department of Public Health, Uludag University School of Medicine, Bursa, Turkey
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Affiliation(s)
- James Smith
- 1 Research Unit on Humanitarian Stakes and Practices (UREPH), Médecins Sans Frontières, Geneva, Switzerland
| | - Tammam Aloudat
- 2 Medical Department, Médecins Sans Frontières, Geneva, Switzerland
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Hunt M, Tansey CM, Anderson J, Boulanger RF, Eckenwiler L, Pringle J, Schwartz L. The Challenge of Timely, Responsive and Rigorous Ethics Review of Disaster Research: Views of Research Ethics Committee Members. PLoS One 2016; 11:e0157142. [PMID: 27327165 PMCID: PMC4915681 DOI: 10.1371/journal.pone.0157142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/25/2016] [Indexed: 11/22/2022] Open
Abstract
Background Research conducted following natural disasters such as earthquakes, floods or hurricanes is crucial for improving relief interventions. Such research, however, poses ethical, methodological and logistical challenges for researchers. Oversight of disaster research also poses challenges for research ethics committees (RECs), in part due to the rapid turnaround needed to initiate research after a disaster. Currently, there is limited knowledge available about how RECs respond to and appraise disaster research. To address this knowledge gap, we investigated the experiences of REC members who had reviewed disaster research conducted in low- or middle-income countries. Methods We used interpretive description methodology and conducted in-depth interviews with 15 respondents. Respondents were chairs, members, advisors, or coordinators from 13 RECs, including RECs affiliated with universities, governments, international organizations, a for-profit REC, and an ad hoc committee established during a disaster. Interviews were analyzed inductively using constant comparative techniques. Results Through this process, three elements were identified as characterizing effective and high-quality review: timeliness, responsiveness and rigorousness. To ensure timeliness, many RECs rely on adaptations of review procedures for urgent protocols. Respondents emphasized that responsive review requires awareness of and sensitivity to the particularities of disaster settings and disaster research. Rigorous review was linked with providing careful assessment of ethical considerations related to the research, as well as ensuring independence of the review process. Conclusion Both the frequency of disasters and the conduct of disaster research are on the rise. Ensuring effective and high quality review of disaster research is crucial, yet challenges, including time pressures for urgent protocols, exist for achieving this goal. Adapting standard REC procedures may be necessary. However, steps should be taken to ensure that ethics review of disaster research remains diligent and thorough.
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Affiliation(s)
- Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Catherine M. Tansey
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
| | - James Anderson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Renaud F. Boulanger
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
| | - Lisa Eckenwiler
- Department of Philosophy & Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, United States of America
| | - John Pringle
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Schwartz
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Abstract
UNLABELLED Introduction Health care workers (HCWs) who participate in humanitarian aid work experience a range of ethical challenges in providing care and assistance to communities affected by war, disaster, or extreme poverty. Although there is increasing discussion of ethics in humanitarian health care practice and policy, there are very few resources available for humanitarian workers seeking ethical guidance in the field. To address this knowledge gap, a Humanitarian Health Ethics Analysis Tool (HHEAT) was developed and tested as an action-oriented resource to support humanitarian workers in ethical decision making. While ethical analysis tools increasingly have become prevalent in a variety of practice contexts over the past two decades, very few of these tools have undergone a process of empirical validation to assess their usefulness for practitioners. METHODS A qualitative study consisting of a series of six case-analysis sessions with 16 humanitarian HCWs was conducted to evaluate and refine the HHEAT. RESULTS Participant feedback inspired the creation of a simplified and shortened version of the tool and prompted the development of an accompanying handbook. CONCLUSION The study generated preliminary insight into the ethical deliberation processes of humanitarian health workers and highlighted different types of ethics support that humanitarian workers might find helpful in supporting the decision-making process.
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Loh LC, Chae SR, Heckman JE, Rhee DS. Ethical considerations of physician career involvement in global health work: a framework. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:129-136. [PMID: 25672614 DOI: 10.1007/s11673-014-9591-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 09/23/2014] [Indexed: 06/04/2023]
Abstract
Examining the ethics of long-term, career involvement by physicians in global health work is vital, given growing professional interest and potential health implications for communities abroad. However, current literature remains heavily focused on ethical considerations of short-term global health training experiences. A literature review informed our development of an ethics framework centered on two perspectives: the practitioner perspective, further subdivided into extrinsic and intrinsic factors, and community perspectives, specifically that of the host community and the physician's home community. Some physician factors included cultural/linguistic differences, power imbalances, and sustainable skills/competencies. Receiving community factors included resource limitations, standard of care disparities, and community autonomy. Home community factors focused on the opportunity cost of an unavailable physician who was trained and supported by the local community. Descriptive review permitted comparison with existing short-term literature, noting similarities and differences. Our framework provides a basis for further research and critical analysis of ethical implications of career-long physician global health work.
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Affiliation(s)
- Lawrence Chew Loh
- Dalla Lana Faculty of Public Health, University of Toronto, 155 College Street West, Sixth Floor, Toronto, ON, M5T 3M7, Canada,
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Asgary R, Lawrence K. Characteristics, determinants and perspectives of experienced medical humanitarians: a qualitative approach. BMJ Open 2014; 4:e006460. [PMID: 25492274 PMCID: PMC4265098 DOI: 10.1136/bmjopen-2014-006460] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 11/03/2014] [Accepted: 11/21/2014] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the characteristics, motivations, ideologies, experience and perspectives of experienced medical humanitarian workers. DESIGN We applied a qualitative descriptive approach and conducted in-depth semistructured interviews, containing open-ended questions with directing probes, with 44 experienced international medical aid workers from a wide range of humanitarian organisations. Interviews were coded and analysed, and themes were developed. SETTING International non-governmental organisations (INGOs) and United Nations (UN). RESULTS 61% of participants were female; mean age was 41.8 years with an average of 11.8 years of humanitarian work experience with diverse major INGOs. Significant core themes included: population's rights to assistance, altruism and solidarity as motives; self-identification with the mission and directives of INGOs; shared personal and professional morals fostering collegiality; accountability towards beneficiaries in areas of programme planning and funding; burnout and emotional burdens; uncertainties in job safety and security; and uneasiness over changing humanitarian principles with increasing professionalisation of aid and shrinking humanitarian access. While dissatisfied with overall aid operations, participants were generally satisfied with their work and believed that they were well-received by, and had strong relationships with, intended beneficiaries. CONCLUSIONS Despite regular use of language and ideology of rights, solidarity and concepts of accountability, tension exists between the philosophy and practical incorporation of accountability into operations. To maintain a humanitarian corps and improve aid worker retention, strategies are needed regarding management of psychosocial stresses, proactively addressing militarisation and neo-humanitarianism, and nurturing individuals' and organisations' growth with emphasis on humanitarian principles and ethical practices, and a culture of internal debate, reflection and reform.
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Affiliation(s)
- Ramin Asgary
- Departments of Medicine and Population Health, New York University School of Medicine, New York, New York, USA
| | - Katharine Lawrence
- Department of Medical Education, Herbert Wertheim College of Medicine, University Park, Miami, Florida, USA
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Lal S, Spence D. Humanitarian Nursing in Developing Countries: A Phenomenological Analysis. J Transcult Nurs 2014; 27:18-24. [PMID: 24848346 DOI: 10.1177/1043659614536585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Surgical nursing within humanitarian contexts is complex, sporadically described in literature and little understood. AIM To achieve a deeper understanding of the lived experience of New Zealand nurses providing humanitarian aid within surgical settings and war zones in developing countries. METHOD In-depth conversational interviews were undertaken with four New Zealand nurses whose humanitarian experience lay in general surgical, military, and intensive care settings. A qualitative descriptive method as described by Sandelowski, informed by van Manen's phenomenology in terms of analysis, was used. RESULTS Specialized knowledge and nursing expertise are recognized to be essential but not sufficient for humanitarian work. Understanding local cultures contributes to positive feelings about work effectiveness. Themes included feeling anxious and misunderstood, practicing differently, and adjusting to life back home. DISCUSSION This study highlights the need to better prepare nurses who volunteer for humanitarian work, with implications for recruiting organizations, educators, and clinicians.
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Affiliation(s)
- Shane Lal
- Auckland University of Technology, Auckland, New Zealand
| | - Deb Spence
- Auckland University of Technology, Auckland, New Zealand
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When and why health care personnel respond to a disaster: the state of the science. Prehosp Disaster Med 2014; 29:270-4. [PMID: 24784878 DOI: 10.1017/s1049023x14000387] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Emergency response relies on the assumption that essential health care services will continue to operate and be available to provide quality patient care during and after a patient surge. The observed successes and failures of health care systems during recent mass-casualty events and the concern that these assumptions are not evidence based prompted this review. METHOD The aims of this systematic review were to explore the factors associated with the intention of health care personnel (HCP) to respond to uncommon events, such as a natural disaster or pandemic, determine the state of the science, and bolster evidence-based measures that have been shown to facilitate staff response. RESULTS Authors of the 70 studies (five mixed-methods, 49 quantitative, 16 qualitative) that met inclusion criteria reported a variety of variables that influenced the intent of HCP to respond. Current evidence suggests that four primary factors emerged as either facilitating or hindering the willingness of HCP to respond to an event: (1) the nature of the event; (2) competing obligations; (3) the work environment and climate; and (4) the relationship between knowledge and perceptions of efficacy. CONCLUSIONS Findings of this study could influence and strengthen policy making by emergency response planners, staffing coordinators, health educators, and health system administrators.
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“How Far Do You Go and Where Are the Issues Surrounding That?” Dilemmas at the Boundaries of Clinical Competency in Humanitarian Health Work. Prehosp Disaster Med 2013; 28:502-8. [DOI: 10.1017/s1049023x13008698] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractYou go from here to there, and here you're specialized in one particular sort of thing, there you may be asked to do all sorts of things outside your specialty. How far do you go and where are the issues surrounding that?Canadian physician discussing experiences in humanitarian aid workHealth professionals working in humanitarian relief projects encounter a range of ethical challenges. Applying professional and ethical norms may be especially challenging in crisis settings where needs are elevated, resources scarce, and socio-political structures strained. Situations when clinicians must decide whether to provide care that is near the margins of their professional competency are a source of moral uncertainty that can give rise to moral distress. The authors suggest that responding ethically to these dilemmas requires more than familiarity with ethical codes of conduct and guidelines; it requires practical wisdom, that is, the ability to relate past experience and general guidance to a current situation in order to render a morally sound action. Two sets of questions are proposed to guide reflection and deliberation for clinicians who face competency dilemmas. The first is prospective and intended to aid clinicians in evaluating an unfolding situation. The second is retrospective and designed to support debriefing about past experiences and difficult situations. The aim of this analysis is to support clinicians in evaluating competency dilemmas and provide ethical care and services.HuntMR, SchwartzL, FraserV. “How Far Do You Go and Where Are the Issues Surrounding That?” Dilemmas at the Boundaries of Clinical Competency in Humanitarian Health Work. Prehosp Disaster Med. 2013;28(5):1-7.
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Coupet S, Del Valle J. A case for an international health elective training program during residency: a four-points call for action. TEACHING AND LEARNING IN MEDICINE 2013; 25:266-271. [PMID: 23848335 DOI: 10.1080/10401334.2013.797347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND International Health Electives (IHE) are becoming more popular among graduate training programs. This is likely due to the high demands from graduating medical students who are seeking to have an international health experience during their post-graduate training. Despite the important educational experiences associated with an IHE, this opportunity does not exist in all graduate medical programs and fewer have formal established programs. SUMMARY We are suggesting that graduate training programs are in a unique position to provide such experiences to our future physicians, in turn creating immediate benefits to host nations as well as long-term impacts on our society in the United States. We are proposing Four Points for stakeholders involved in training future physicians to use as they consider designing such opportunities for future trainees. The four points include: residents are capable of providing service to host nations, improve the quality of care to communities in the U.S., foster graduating medical students' global health interests and increase global health mentorship. CONCLUSIONS We hope that addressing these four points will reemphasize the importance of establishing an IHE in all graduate training programs.
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Affiliation(s)
- Sidney Coupet
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA.
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Hunt MR, Schwartz L, Sinding C, Elit L. The Ethics of Engaged Presence: A Framework for Health Professionals in Humanitarian Assistance and Development Work. Dev World Bioeth 2012; 14:47-55. [DOI: 10.1111/dewb.12013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hunt MR, Sinding C, Schwartz L. Tragic Choices in Humanitarian Health Work. THE JOURNAL OF CLINICAL ETHICS 2012. [DOI: 10.1086/jce201223407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Schwartz L, Hunt M, Sinding C, Elit L, Redwood-Campbell L, Adelson N, de Laat S. Models for Humanitarian Health Care Ethics. Public Health Ethics 2012. [DOI: 10.1093/phe/phs005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Disasters, humanitarian responses, and critical care. Pediatr Crit Care Med 2011; 12:468-70. [PMID: 21799309 DOI: 10.1097/pcc.0b013e3182196eae] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Hunt MR. Establishing moral bearings: ethics and expatriate health care professionals in humanitarian work. DISASTERS 2011; 35:606-22. [PMID: 21410748 DOI: 10.1111/j.1467-7717.2011.01232.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Expatriate health care professionals frequently participate in international responses to natural disasters and humanitarian emergencies. This field of practice presents important clinical, logistical and ethical challenges for clinicians. This paper considers the ethics of health care practice in humanitarian contexts. It examines features that contribute to forming the moral landscape of humanitarian work, and discusses normative guidelines and approaches that are relevant for this work. These tools and frameworks provide important ethics resources for humanitarian settings. Finally, it elaborates a set of questions that can aid health care professionals as they analyse ethical issues that they experience in the field. The proposed process can assist clinicians as they seek to establish their moral bearings in situations of ethical complexity and uncertainty. Identifying and developing ethics resources and vocabulary for clinical practice in humanitarian work will help health care professionals provide ethically sound care to patients and communities.
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Affiliation(s)
- Matthew R Hunt
- Centre for Research on Ethics, University of Montreal, Canada.
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Schwartz L, Sinding C, Hunt M, Elit L, Redwood-Campbell L, Adelson N, Luther L, Ranford J, DeLaat S. Ethics in Humanitarian Aid Work: Learning From the Narratives of Humanitarian Health Workers. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/21507716.2010.505898] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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